What Is The Ideal Strategy For Posterior Calcaneal Spur

Overview

Although a heel spur is often thought to be the source of heel pain, it rarely is. When a patient has plantar fasciitis, the plantar fascia pulls on the bottom of the heel bone. Over time this can cause a spur to form. Heels spurs are a very common x-ray finding, and because the heel spur is buried deep in soft tissue and not truly in a weight bearing area, there is often no history of pain. It is important to note that less than one percent of all heel pain is due to a spur. but frequently caused by the plantar fascia pulling on the heel. Once the plantar fasciitis is properly treated, the heel spur could be a distant memory.

Causes

The calcaneal spur is seen most often in persons over the age of 40. The condition can also be associated with osteoarthritis, rheumatoid arthritis, poor circulation of the blood and other degenerative diseases. Men and women are equally likely to have them.

Symptoms

Some symptoms at the beginning of this condition include pain and swelling, and discomfort when pushing off with the toes during walking. This movement of the foot stretches the fascia that is already irritated and inflamed. If this condition is not treated, pain will be noticed in the heel when a heel spur develops in response to the stress. This is a common condition among athletes and others who run and jump a significant amount.

Diagnosis

Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.

Non Surgical Treatment

Heel spurs and plantar fascitis (inflammation of the plantar fascia) are usually controlled with conservative treatment. Early intervention includes stretching the calf muscles while avoiding reinjury to the plantar fascia. Decreasing or changing activities, losing excess weight, and improving the fit of shoes are all important measures to decrease foot pain. Modification of footwear includes well-padded shoes with a raised heel and better arch support. Shoe inserts recommended by a healthcare professional are often very helpful when used with exercises to increase the strength of the foot muscles and arch. The inserts prevent excessive pronation and continued tearing of the plantar fascia.

Surgical Treatment

Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well. Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.

Prevention

In order to prevent heel spurs, it?s important that you pay attention to the physical activities you engage in. Running or jogging on hard surfaces, such as cement or blacktop, is typical for competitive runners, but doing this for too long without breaks can lead to heel spurs and foot pain. Likewise, the shoes you wear can make a big difference in whether or not you develop heel spurs. Have your shoes and feet checked regularly by our Dallas podiatrist to ensure that you are wearing the proper equipment for the activities. Regular checkups with a foot and ankle specialist can help avoid the development of heel spurs.